Sainte-Foy-lès-Lyon, France
Sainte-Foy-lès-Lyon, France

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Guibal A.,Service dImagerie Abdominale | Boularan C.,Service dImagerie Abdominale | Bruce M.,Service dImagerie Abdominale | Bruce M.,SuperSonic Imagine | And 7 more authors.
European Radiology | Year: 2013

Objectives: To determine the elasticity characteristics of focal liver lesions (FLLs) by shearwave elastography (SWE). Methods: We used SWE in 108 patients with 161 FLLs and in the adjacent liver for quantitative and qualitative FLLs stiffness assessment. The Mann-Whitney test was used to assess the difference between the groups of lesions where a P value less than 0.05 was considered significant. Results: SWE acquisitions failed in 22 nodules (14 %) in 13 patients. For the 139 lesions successfully evaluated, SWE values were (in kPa), for the 3 focal fatty sparings (FFS) 6.6 ± 0.3, for the 10 adenomas 9.4 ± 4.3, for the 22 haemangiomas 13.8 ± -5.5, for the 16 focal nodular hyperplasias (FNHs) 33 ± -14.7, for the 2 scars 53.7 ± 4.7, for the 26 HCCs 14.86 ± 10, for the 53 metastasis 28.8 ± 16, and for the 7 cholangiocarcinomas 56.9 ± 25.6. FNHs had significant differences in stiffness compared with adenomas (P = 0.0002). Fifty percent of the FNHs had a radial pattern of elevated elasticity. A significant difference was also found between HCCs and cholangiocarcinomas elasticity (P = 0.0004). Conclusions: SWE could be useful in differentiating FNHs and adenomas, or HCCs and cholangiocarcinomas by ultrasound. Key Points: • Elastography is becoming quite widely used as an adjunct to conventional ultrasound • Shearwave elastography (SWE) could help differentiate adenomas from fibrous nodular hyperplasia • SWE could also be helpful in distinguishing between hepatocellular carcinomas and cholangiocarcinomas • SWE could improve the identify hepatocellular carcinomas in cirrhotic livers © 2012 European Society of Radiology.


Euvrard S.,Edouard Herriot Hospital Group | Morelon E.,Edouard Herriot Hospital Group | Morelon E.,University of Lyon | Morelon E.,French Institute of Health and Medical Research | And 19 more authors.
New England Journal of Medicine | Year: 2012

Background: Transplant recipients in whom cutaneous squamous-cell carcinomas develop are at high risk for multiple subsequent skin cancers. Whether sirolimus is useful in the prevention of secondary skin cancer has not been assessed. Methods: In this multicenter trial, we randomly assigned transplant recipients who were taking calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma either to receive sirolimus as a substitute for calcineurin inhibitors (in 64 patients) or to maintain their initial treatment (in 56). The primary end point was survival free of squamous-cell carcinoma at 2 years. Secondary end points included the time until the onset of new squamous-cell carcinomas, occurrence of other skin tumors, graft function, and problems with sirolimus. Results: Survival free of cutaneous squamous-cell carcinoma was significantly longer in the sirolimus group than in the calcineurin-inhibitor group. Overall, new squamous-cell carcinomas developed in 14 patients (22%) in the sirolimus group (6 after withdrawal of sirolimus) and in 22 (39%) in the calcineurin-inhibitor group (median time until onset, 15 vs. 7 months; P = 0.02), with a relative risk in the sirolimus group of 0.56 (95% confidence interval, 0.32 to 0.98). There were 60 serious adverse events in the sirolimus group, as compared with 14 such events in the calcineurininhibitor group (average, 0.938 vs. 0.250). There were twice as many serious adverse events in patients who had been converted to sirolimus with rapid protocols as in those with progressive protocols. In the sirolimus group, 23% of patients discontinued the drug because of adverse events. Graft function remained stable in the two study groups. Conclusions: Switching from calcineurin inhibitors to sirolimus had an antitumoral effect among kidney-transplant recipients with previous squamous-cell carcinoma. These observations may have implications concerning immunosuppressive treatment of patients with cutaneous squamous-cell carcinomas. Copyright © 2012 Massachusetts Medical Society.


Haesebaert J.,Pole Information Medicale Evaluation Recherche | Haesebaert J.,University Claude Bernard Lyon 1 | Termoz A.,Pole Information Medicale Evaluation Recherche | Polazzi S.,Pole Information Medicale Evaluation Recherche | And 8 more authors.
Stroke | Year: 2013

BACKGROUND AND PURPOSE - : Because acute ischemic strokes (ISs) are mainly hospitalized, hospital discharge data could be used to routinely follow their incidence management. We aimed to assess sensitivity and positive predictive value of the French hospital discharge database (HDD) to identify patients with acute IS using a prospective and exhaustive cohort (AVC69) of acute IS cases. METHODS - : A selection algorithm based on IS diagnosis coded with the International Classification of Diseases (ICD-10) and cerebral imaging codes was used to identify all hospital stays with the primary diagnosis of IS in the HDD of the university hospitals of the Rhône area. Cases identified through HDD search were compared with IS cases identified through an exhaustive cohort study conducted in the Rhône district and confirmed on medical records review. RESULTS - : There were 465 confirmed cases of IS hospitalized in 1 of the 4 university hospitals during the study period. The HDD search identified 313 among those (true-positive cases) but missed 152 cases (false-negative cases). The sensitivity of the HDD search was 67.3% (95% confidence interval, 63.1-71.5), and the positive predictive value was 95.1% (95% confidence interval, 92.8-97.4). Additionally, HDD search retrieved 16 cases, which were not eventually IS (false positives). Sensitivity was better when patients were hospitalized in neurological departments. CONCLUSIONS - : The lack of sensitivity to identify acute IS patients through HDD search does not seem to be accurate enough to validate the use of these data for incidence estimates. Efforts have to be made to improve the coding quality. © 2013 American Heart Association, Inc.


Chabroux S.,Edouard Herriot Hospital | Canoui-Poitrine F.,Pole information medicale evaluation recherche | Canoui-Poitrine F.,University of Lyon | Reffet S.,Edouard Herriot Hospital | And 5 more authors.
Diabetes and Metabolism | Year: 2010

Aims: Advanced glycation end products (AGEs) are thought to play a central role in the pathogenesis of diabetes complications. For this reason, a non-invasive tool using skin autofluorescence (AF) quantification that correlates with levels of tissue AGEs has been developed. The present study aimed to assess whether or not skin AF is associated with microvascular complications in patients with type 1 diabetes (T1D). Methods: All consecutive patients with T1D (n = 133) had three AF measures taken on the forearm, using illumination with a fluorescent tube, all on the same day after breakfast or lunch. Potential associations between skin AF levels and microvascular complications, age, diabetes duration and health status were then assessed using a multivariate linear-regression model. Results: On age-adjusted analyses, diabetes duration, retinopathy, nephropathy and neuropathy were significantly associated with skin AF levels (all P < 0.001). AF levels increased significantly with severity in both retinopathy and nephropathy (P < 0.001). After adjusting for age, diabetes duration, HbA1c, smoking, retinopathy, nephropathy and neuropathy, the association of AF levels remained significant with nephropathy and neuropathy, but not with retinopathy and diabetes duration. Conclusion: This study suggests an independent association between skin AF levels and diabetic nephropathy and neuropathy, but not retinopathy, in T1D patients. Prospective studies are needed to confirm the ability of skin AF levels to predict microangiopathy. © 2010 Elsevier Masson SAS. All rights reserved.


De Lattre C.,Pediatric Neuromuscular Disease Reference Center | Payan C.,Hopital Pitie Salpetriere | Vuillerot C.,Pediatric Neuromuscular Disease Reference Center | Rippert P.,Pole Information Medicale Evaluation Recherche | And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2013

Objective: To validate a useful version of the Motor Function Measure (MFM) in children with neuromuscular diseases aged <7 years old. Design: Two prospective cohort studies that documented the MFM completion of children aged between 2 and 7 years old. Setting: French-speaking rehabilitation departments from France, Belgium, and Switzerland. Participants: Healthy children (n=194) and children with a neuromuscular disease (n=88). Interventions: Patients were rated by the MFM either once or twice by trained medical professionals, with a delay between the 2 MFMs ranging between 8 and 30 days. Main Outcome Measure: Intra- and interrater reliability of the MFM. Results: The subtests making up the MFM-32, a scale monitoring severity and progression of motor function in patients with a neuromuscular disease in 3 functional domains, were carried out in healthy children aged 2 to 7 years. Twenty items of the MFM-32 were successfully completed by these children and were used to constitute the MFM-20. Principal component analysis of the MFM-20 confirmed the 3 functional domains. Inter- and intrarater reliability of the 3 subscores and total score were high (intraclass correlation coefficient >.90), and discriminant validity was good. Conclusions: The MFM-20 can be used as an outcome measure for assessment of motor function in young children with neuromuscular disease. © 2013 by the American Congress of Rehabilitation Medicine.


Duclos A.,Pole Information Medicale Evaluation Recherche | Duclos A.,University of Lyon | Voirin N.,CNRS Biometry and Evolutionary Biology Laboratory
International Journal for Quality in Health Care | Year: 2010

Background: The p-chart is a user-friendly tool for monitoring adverse events. By converting data into knowledge, it is helpful in interpreting and reducing sources of variability in care. Certain basics for developing expertise to use p-charts correctly are necessary. Purpose: This paper provides key elements on how to develop and interpret a p-chart for clinical practice, how to successfully integrate this tool within a comprehensive approach, and how to report a study based on p-chart utilization. P-chart building: The p-chart combines time series analysis with a graphical presentation of data by plotting successive indicator measurements in chronological order. The pragmatic choice of well-defined indicators to be monitored is essential. Exact control limits based on the binomial distribution and the incorporation of risk adjustment represent important contributions for further improving the tool's performance in health-care settings. P-chart implementation: The solution needed to reduce adverse events is not available from measurement alone. The success of routine introduction of the p-chart requires investigation of the causes of indicator variations and the trying out of quality improvement initiatives. It must be supported by strong management leadership within an atmosphere of constructive evaluation. Perspectives: The implementation of the p-chart into clinical practice encourages practitioners to continuously undertake a critical examination of the care delivered. Nearly a century after it was created in the manufacturing industry, the control chart now contributes to improving the quality of health-care processes and patient safety. © The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.


Rhondali W.,University of Houston | Rhondali W.,Center Hospitalier Of Lyon Sud | Perceau E.,Center Hospitalier Of Lyon Sud | Berthiller J.,Pole Information Medicale Evaluation Recherche | And 6 more authors.
Supportive Care in Cancer | Year: 2012

Purpose Depression occurs among an estimated 15% of cancer patients (range, 1-77.5%). Our main objective was to identify the frequency of reported depression by using the Brief Edinburgh Depression Scale (BEDS) among cancer outpatients. Our secondary objective was to identify associated symptoms of cancer using the Edmonton Symptom Assessment System (ESAS) and to evaluate the screening performance of depression between ESAS and BEDS. Methods In this multicenter prospective study conducted, we used the ESAS to collect information on nine symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, shortness of breath, lack of appetite, and feeling of well-being (each rated from 0 to 10). The BEDS was used to assess for "probable depression" (score >6). Data were analyzed using a parametric and nonparametric test. Results A total of 146 patients completed the study. The prevalence of probable depression was 43/146 (29%). Probable depression was associated with increased fatigue (p=0.008), depression (p<0.0001), anxiety (p<0.0001), shortness of breath (p=0.01), and decreased feeling of well-being (p<0.001). Among patients with probable depression, 42 (98%) patients were not using antidepressants. Regarding the sensitivity and the specificity, we determined that the optimal cutoff for using the ESAS as a depression screening tool was ≥2. Conclusion We found significant associations between probable depression as determined with the BEDS and five symptoms as detected with the ESAS. The vast majority of patients with probable depression were not receiving pharmacological treatment. Depression should be suspected in patients with higher symptom distress as for any one of these 5 ESAS items. © Springer-Verlag 2012.


PubMed | International Agency of Research on Cancer, Rennes University Hospital Center, CNRS Biometry and Evolutionary Biology Laboratory, Service de medecine physique et readaptation and 2 more.
Type: Journal Article | Journal: BMJ open | Year: 2017

Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective.We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the weight-bearing asymmetry (WBA), the centre of pressure (COP) and the limit of stability (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and full-text articles, evaluate the risk of bias and will perform data extraction. In addition to the outcomes, measures of independence will be analysed. This study will aim at determining the effects of PT on the function (WBA, COP, LOS), the activity (BBS, PASS) and the independence of patients. Subgroup analyses will be planned according to the location of brain lesion (hemispheric, brainstem or cerebellum), the time since stroke (early, late, chronic), the PT (type, main aim (direct effect or generalisation), overall duration), the type of approaches (top-down or bottom-up) and the methodological quality of studies.No ethical statement will be required. The results will be published in a peer-reviewed journal. This meta-analysis aims at managing the rehabilitation after postural imbalance by PT after a stroke.Prospero CRD42016037966;Pre-results.


PubMed | University of Washington, University of Lyon, Service de Reanimation Medicale and Pole Information Medicale Evaluation Recherche
Type: Journal Article | Journal: Journal of evaluation in clinical practice | Year: 2016

In the global context of population ageing, understanding and monitoring intensive care use by the elderly is a strategic issue. National-level data are needed to overcome sampling biases that often limit epidemiologic studies of the critically ill elderly. The objective of this study was to describe intensive care use for hospitalized elderly patients using secondary data from the French national hospital discharge database.Structured assessment of the national database coverage and accuracy; cross-sectional analysis of hospitalizations including at least one admission in an intensive care unit (ICU) for patients aged80 years from 1January to 31December 2009.In 2009, people aged80 years accounted for 5.4% of the population but 15.3% of the 215210 adult hospitalizations involving intensive care in France. In this elderly group, the mean age was 84.0 (3.56) years, and 51.6% were male. In-hospital mortality was 33.9%. The median time spent in the ICU was 3 [interquartile range (IQR), 2-8] days, the median time spent in hospital was 14 (IQR, 8-24) days and 9% of hospitalizations ended by the patients death involved intensive care. A surgical procedure was included in 43% of hospitalizations. Medical and surgical diagnosis-related group hospitalizations were characterized by significant differences in volume, mortality, ICU days and costs.There was marked clinical heterogeneity in the population of elderly patients hospitalized in the ICU. These data provide baseline information and prompt further studies comparing intensive care utilization across age groups, between countries and over time.


PubMed | University of Lyon and Pole Information Medicale Evaluation Recherche
Type: Journal Article | Journal: Neuroradiology | Year: 2016

Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis.We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis.HT occurred in 31 patients (17%). Baseline National Institute of Health Stroke Score (NIHSS; p=0.008), severe LA (p=0.02), and diffusion lesion volume (p=0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p=0.03).In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size.

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